Male pattern baldness (MPB) affects more than 35 million men in the United States. It correlates closely with age whereby about thirty percent of men experience MPB by age thirty, forty percent by age forty and so on. For more than thirty years doctors have been refining the technique of harvesting a plurality of hairs from donor sites on the scalp and transplanting them to the areas of hair loss. It is not well known that hair loss is not associated with scalp location but with the particular type of hair follicle, which differs from site to site. Therefore, healthy follicles from a site where hair has not been lost will flourish when transplanted to a site where hair had been lost.
Early attempts at transplantation involved removing of circular plugs of hair from a donor site and inserting them into circular recipient holes in another site. Surgeons now remove long rectangular sections of scalp from the donor site which is then closed by suturing or stapling the remaining parallel cut edges of scalp together. This leaves a long, straight mild scar, which is not visible when it becomes covered by hair. The donor tissue is then cut into sections, each containing one or more hair follicles, in sizes that will match the size and shape of the recipient sites.
In order to avoid the unattractive "corn row" appearance, most surgeons prefer to implant narrow rectangular sections of donor tissue or donor grafts so that the normal pattern of hair growth can be approximated. The recipient sites have generally been created by making slits with a scalpel or laser. These methods have not been fully successful, because the mass of the tissue plug is greater than the slit that has been created for it. The result is often graft compression which causes a clumpy appearance. Optimal blood flow is not achieved and healing is compromised, resulting in incomplete survival of the donor hair follicles. If the grafts are pushed upward during healing, a series of bumps or ripples in the scalp will result.
The use of circular scalp punches of varying sizes involved puncturing the scalp with the sharpened circular tip of the punch to a depth of several millimeters and then removing the circular tissue plugs. These punches are essentially hollow tubes, sharpened at one end, with one or more relief holes to allow blood and tissue an escape path after the holes have been made. The circular punch was initially selected because it was an obvious cutting tool with a history of use in securing tissue biopsies. It was also readily available, inexpensive and easy to use. It made a clean, round circular cut and could be matched in size to the diameter of the donor graft.
Hair transplant plugs have to be made or harvested from other portions of the scalp where there is a healthy growth of hair. An area approximately three quarters of an inch by five inches, for example, is usually removed from the back of the head. The edges are parallel top and bottom and the sides taper to points so that the edges can be brought together to form a straight suture line. The slab of skin which includes hundreds to several thousand hair follicles is then sliced longitudinally and horizontally to produce the individual plugs each having from one to five or more hair follicles. By this method each donor plug is essentially a rectangle in shape or a square. When placed into a round opening which has been prepared to receive the transplant a good fit is not always achieved because of the disparity between their shapes. While the plug is very soft and may tend to conform its rectangular shape and straight sides to a circular hole, it clearly is not a mating fit.
It was discovered over a period of time that a pattern of round holes creates an unnatural look as regards the appearance of hair in a person's scalp. Normal hair does not grow in round sites or in a pattern of such sites.
A relatively new development to improve on these problems is a device called the linear punch which is a punch having a generally rectangular shape as opposed to round. The result is that hair plugs of a rectangular shape fit more appropriately into a generally rectangular shape hole, and furthermore the transplant plugs being essentially linear create the impression of lines of hairs as opposed to round spots. When these lines are properly located in an appropriate pattern, the eventual hair growth has a more much natural look because the extended hair will grow and overlap spaces between adjacent lines and the result is cosmetically desirable and superior.
The linear punch referred to above has parallel sides and round or semicircular ends. This punch is formed as a hollow tube, typically round along its stem until reaching the cutting end which is then partially flattened to create the above-mentioned parallel sides and rounded ends. This punch produces a generally rectangular opening for receiving a generally rectangular transplant hair plug. This linear punch is secured to a handle, and the surgeon makes a great many manually punched holes in the scalp. The spacing and pattern of the holes and the depth of each hole is determined essentially by the surgeon's skill, experience and aesthetic decision about the scalp surface being punched.
In the punching procedure each time a penetration of the scalp is made and the surface is cut to the determined depth, a small bit of tissue is forced up into the opening of the punch bore. After a plurality of punch strokes some tissue and blood can travel upward through the hollow bore of the punch and exit through a relief hole in an upper portion of the stem of the punch. Sometimes after the punch is withdrawn from a site, the cut tissue either remains in the site or stays in the punch. The surgeon removes dangling tissue on the scalp by wiping the surface with a comb or cloth or by other methods such as grasping forceps and removed tissue from the punch by shaking it.
The surgical technique used with the above-mentioned linear punch and the punch itself constitutes a considerable improvement over prior methods and devices and in the health and cosmetic appearance of the hair transplant result.